Shiga toxin-producing Escherichia coli (STEC) are the most virulent diarrheagenic E. coli known to date. They can be
spread with alarming ease via food as exemplified by a large sprout-borne outbreak of STEC O104:H4 in 2011 that
was centered in northern Germany and affected several countries. Effective control of such outbreaks is an
important public health task and necessitates early outbreak detection, fast identification of the outbreak vehicle
and immediate removal of the suspected food from the market, flanked by consumer advice and measures to
prevent secondary spread.
In our view, opportunities to improve control of STEC outbreaks lie in early clinical suspicion for STEC infection,
timely diagnosis of all STEC at the serotype-level and integrating molecular subtyping information into surveillance
systems. Furthermore, conducting analytical studies that supplement patients’ imperfect food history recall and
performing, as an investigative element, product tracebacks, are pivotal but underutilized tools for successful
epidemiologic identification of the suspected vehicle in foodborne outbreaks. As a corollary, these tools are
amenable to tailor microbiological testing of suspected food.

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